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Could this virus test replace the Pap smear?
07 July 2018, 10:03 | Melissa Porter
HPV test is more effective in cervical cancer diagnosis
A study from Canada found that an initial test for human papilloma virus (HPV), which causes nearly all cases of cervical cancer, led to the discovery of more pre-cancerous lesions than were found with conventional smear tests. However, the U.S. Preventive Services Task Force, which creates guidelines for the diseases people should be screened for and when, still recommends Pap smears every three years for most women with uteruses ages 30 to 65, NPR reports.
Suboptimal specificity of the HPV test is still a limiting factor for widespread adoption of the test as a cancer screening tool, write the authors of the editorial, "especially among populations of young women who often carry HPV infections that regress without oncogenic outcome". That's what some experts believe after a new study found that the HPV test detects precancerous cervical changes earlier and more accurately. They also found that women with negative HPV test were more likely to not have cancer for the next four years, compared to the ones that had a negative Pap test. The goal was to examine the clinical utility of both tests to predict grade 2 or 3 cervical intraepithelial neoplasia (CIN) lesions (CIN2+ or CIN3+, respectively). Rising geriatric population will also add fuel this market, as they will further demand for more cancer assays and tests and hence will contribute towards the growth of this market in future. But last fall, it issued a draft recommendation proposing that women undergo either HPV testing every five years or Pap smears every three years, but a final recommendation has not been released. Gynecologic oncologist Dr. Kathleen Schmeler at the University of Texas MD Anderson Cancer Center, said in a statement, "In our world, this study is going to be a pretty big deal, in a good way". He said that although the study confirmed previous research showing that the HPV test is more sensitive than the Pap test, it didn't answer a critical question: Is the HPV test alone better than the HPV test and the Pap smear together, as is current practice?
This means that women may need to be screened less frequently but have more accurate results. The women who tested negative with the HPV test returned four years later. They checked on almost 19,000 women and found that detecting HPV was more predictive of early stage cervical cancer than the routine Pap tests. Dr Kathleen Schmeler, a gynaecologic oncologist at The University of Texas MD Anderson Cancer Center said, "The bottom line is that it could really potentially simplify how we screen women and have it been more effective and not quite as complicated and burdensome - and opens the door for doing just HPV testing which is actually what's now recommended by the World Health Organisation for countries that don't have Pap testing capabilities". The study is important in informing screening methods as the American Cancer Society estimates around 13,000 American women will be diagnosed with cervical cancer, and about 4,170 will die from it.
"Look for changes to screening guidelines to favor HPV testing over Pap testing, and expect a shift to longer intervals between screens", said Massad, who wrote an editorial accompanying the study.
HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab - a less invasive process than the Pap.
Researchers recruited 19,009 women to have initial screening either by HPV test or smear test, with around half randomly assigned to each group.
Most cases are preventable with screening the best way of catching it before it develops. They focused mainly on moderate or severe changes to cervical cells (pre-cancerous changes) that could lead to cervical cancer. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period. Fewer cases of precancer were found in the HPV group, since that group had already had more precancerous signs identified and treated.
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